In a Taiwanese study reported in the Journal of Clinical Oncology, Hsu et al found that survivors of childhood and adolescent cancers were at a significantly increased risk of multiple major psychiatric disorders compared to those without cancer.
Study Details
The study used data from a nationwide data set (National Health Insurance Research Database) on 5,121 survivors of eight organ system–related cancers matched 1:10 on demographic characteristics with 51,210 noncancer controls. Risks for seven disorders were evaluated: autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), schizophrenia, bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).
Key Findings
Mean age at cancer diagnosis was 9.1 years (standard deviation = 5.7 years). Median follow-up was 11 years.
Incidence of major psychiatric disorders among survivors was 14.26% for ADHD, 5.66% for MDD, 2.34% for ASD, 1.37% for BD, 1.17% for OCD, 0.78% for schizophrenia, and 0.59% for PTSD.
Survivors were at significantly increased risk of:
- ASD (hazard ratio [HR] = 10.42, 95% confidence interval [CI] = 4.58–23.69)
- ADHD (HR = 6.59, 95% CI = 4.91–8.86)
- BD (HR = 2.93, 95% CI = 1.26–6.80)
- MDD (HR = 1.88, 95% CI = 1.26–2.79)
- OCD (HR = 3.37, 95% CI = 1.33–8.52)
- PTSD (HR = 6.10, 95% CI = 1.46–25.54).
Risk of schizophrenia was not significantly increased (HR = 1.87, 95% CI = 0.64–5.41).
Survivors were significantly younger vs controls at age of diagnosis of ADHD (mean = 8.3 vs 9.5 years, P = .028), schizophrenia (17.8 vs 20.6 years, P = .048), MDD (17.9 vs 20.1 years, P < .001), and OCD (15.3 vs 19.4 years, P = .011).
The risks of major psychiatric disorder diagnoses varied according to specific cancer types. Cancers significantly associated with the greatest number of individual disorders (four each) were brain cancer (ADHD, HR = 12.25; MDD, HR = 3.52; OCD, HR = 8.78; and PTSD, HR = 18.50) and lymphatic/hematopoietic cancers (ASD, HR = 9.00; ADHD, HR = 6.52; BD, HR = 4.84; and OCD, HR = 4.25).
The investigators concluded, “We found that childhood and adolescent cancer survivors were at higher risks of major psychiatric disorder diagnoses than controls. Follow-up care should include psychosocial interventions focusing on early signs of mental health problems and early interventions in this high-risk group.”
Mu-Hong Chen, MD, of the Department of Psychiatry, Taipei Veterans General Hospital, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by Taipei Veterans General Hospital, Yen Tjing Ling Medical Foundation, and Ministry of Science and Technology, Taiwan. For full disclosures of the study authors, visit ascopubs.org.
